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Extortion and the Ethics of “Topping Up”

Published online by Cambridge University Press:  01 October 2009

BENJAMIN SACHS
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Extract

In November 2008 Professor Mike Richards issued his much awaited review of the British Department of Health's policy on out-of-pocket payments (“top-ups”) for drugs not approved as cost effective by the National Institute for Health and Clinical Excellence (NICE). The policy stated, or had been construed as stating, that those who top up thereby became ineligible for further National Health Service (NHS) treatment for the condition targeted by the drug. For instance, if a lung cancer sufferer bought Avastin, which is not NICE approved, she could no longer receive free treatment for her cancer on the NHS's tab. Richards, the National Cancer Director, recommended that the policy be repealed. From an ethical point of view, this change should be enthusiastically welcomed.

Type
Perspectives
Information
Cambridge Quarterly of Healthcare Ethics , Volume 18 , Issue 4 , October 2009 , pp. 443 - 445
Copyright
Copyright © Cambridge University Press 2009

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References

1. Department of Health. A code of conduct for Private Practice. London: Crown; 2004; available from http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_085197 (last accessed 6 Oct 2008).

2. Bloor K. Should patients be able to pay top-up fees to receive the treatment they want? No. British Medical Journal 2008;336:1105.

3. Douglas T. Paying to top up NHS treatment. Oxford: Practical Ethics. 2008 Jul. Available from http://www.practicalethicsnews.com/practicalethics/2008/07/paying-to-top-u.html (last accessed 1 Oct 2008).

4. Lees CC. Not allowing top-up fees is unethical. British Medical Journal 2008;336:1205.

5. Gubb J. Should patients be able to pay top-up fees to receive the treatment they want? Yes. British Medical Journal 2008;336:1104.

6. The King's Fund. The King's Fund's response to Department of Health review of additional private drugs for NHS care; available from http://www.kingsfund.org.uk/media/top_ups_response.html (last accessed 1 Oct 2008).

7. Sachs BA. The liberty principle and universal health care. Kennedy Institute of Ethics Journal 2008;18:149–72.

8. See note 6, The King's Fund 2008.